Adult male survivors of childhood sexual abuse

This paper outlines the conclusions drawn from a qualitative research study which involved in-depth interviews with 2.5 adult males who had been sexually abused during childhood. The full findings have been described in Adult Male Survivors of Childhood Sexual Abuse published by Pitman (1995). The book includes many of the men's first person accounts of their experiences of abuse.     

Psychodynamic group therapy for male survivors of sexual abuse

The group therapy literature on male sexual abuse is very preliminary and concerned solely with short-term support models. This paper describes a long-term psychodynamic therapy group for male survivors that has been running successfully in a clinic setting for almost three years. This combined group and individual treatment approach presupposes the selection of men who are capable of using group process to explore basic personality and relationship problems. With sexually abused men, certain treatment issues are paramount. These concern the safety of group boundaries, power and control, facilitating intimacy, handling shame and guilt, and the effects of trauma. Special attention is given to the gender-related dynamics and conflicts that occur in a group of male survivors with a male leader.     

An evidence-based group coping intervention for women living with HIV and history of childhood sexual abuse

Women living with HIV/AIDS and a history of childhood sexual abuse often exhibit sexual trauma symptoms and elevated rates of HIV-risk behaviors. In this paper, we describe a coping skills group intervention that reduced traumatic stress and sexual-risk behavior in a recent randomized clinical trial. We focused on clinical issues that emerged among female participants receiving the intervention. Clinical observations showed that recognizing connections between trauma, psychological distress, and high risk behaviors was a new and powerful experience for many participants. Participants successfully applied psychoeducational material, expressing an increased sense of power and control over their relationships and behaviors as they developed more adaptive cognitive and behavioral skills. Women expressed high levels of satisfaction with the intervention. Recommendations for clinical practice are provided.     

Flashback phenomena in survivors of childhood sexual abuse: A four-stage treatment model

There has been a growing awareness of Post-Traumatic Stress Disorder (PTSD) as a consequence of childhood sexual trauma. Central to this diagnosis is the flashback experience. Flashbacks are essentially memories which have not been integrated into everyday consciousness and return as intrusive symptoms, usually accompanied by dread and panic. This article presents a treatment strategy based on a four-stage model. The model includes (1) education; (2) assisting clients in identifying their flashback patterns; (3) designing coping strategies; and (4) processing the flashback. The goal is to assist the client with the management and integration of traumatic memory.This article is based on a paper practical guidelines to treating incest survivors' flashbacks presented at the World Congress of Cognitive Therapy, Toronto, June 1992.     

A short-term group therapy model for treatment of adult female survivors of childhood incest

Childhood incest has been experienced by a minimum of one million American women. Because of the dynamic of secrecy in these families and society's discomfort with the issue, disclosure frequently does not take place until adulthood. A treatment modality for adult women following disclosure of a childhood incest experience has been devised. A short-term semi-structured group model has been chosen which creates an atmosphere of rapid cohesion and helps participants broaden their identity beyond that of victim. This paper reports participants' demographic and historical data as well as thematic content and group evaluative data from the first nine such groups conducted in a major health maintenance organization in the Boston area. Findings suggest that childhood incest has widespread and long-lasting effects on women's functioning, including ability to trust and form relationships, emotional functioning and self-esteem, and the ability to protect self and children from victimization. The group was felt to be extremely valuable by the majority of participants and was experienced by many as the first place they ever found safety, unconditional nurturance, and a sense of belonging. Other findings include the repetition of incest over generations, the nonresponsiveness of adults in cases where disclosure had taken place in childhood, and the importance of an empathic yet well-bounded therapist.     

Supervising counsellors who work with survivors of childhood sexual abuse

This paper draws attention to issues for supervisors who support counsellors working with adult survivors of childhood sexual abuse from the perspective of trauma theory. The author describes the effects of vicarious traumatization and the unconscious dynamics that contribute to this experience. A narrative approach is included as another way of supervisors listening to distressing stories, both those of clients and of their counsellors, and reflects on the value of bearing witness to those stories in supervision and of recognizing them as a source of healing.     

Developing a model for online support group use, empowering processes and psychosocial outcomes for individuals living with HIV/AIDS

This study examined the mechanism through which online support group (OSG) participation may promote patient empowerment among 340 individuals living with HIV/AIDS. Results from structural equation modelling revealed that greater use of OSGs was associated with more frequent occurrence of the empowering processes as measured by receiving useful information, receiving social support, finding positive meaning and helping others. Receiving useful information and finding positive meaning were related to higher levels of adaptive coping and lower levels of maladaptive coping, while receiving social support and helping others were related to higher levels of self-care self-efficacy, which in turn was related to higher levels of adaptive coping, and lower levels of maladaptive coping. Finally, higher levels of maladaptive coping were related to poorer quality of life, while higher levels of adaptive coping were related to better quality of life. Results suggest that OSG participation may offer some benefits for those living with HIV/AIDS.     

A qualitative study of childhood sexual abuse survivors in Taiwan: toward a transactional and ecological model of coping

In this study, we aimed to explore the experiences of 10 female Taiwanese childhood sexual abuse (CSA) survivors (age range = 20-39 years) to broaden our understanding of the post-abuse coping process in a Chinese sociocultural context. This investigation was grounded on a feminist paradigm, and the consensual qualitative research method (Hill et al., 2005; Hill, Thompson, & Williams, 1997) was utilized as the strategy of inquiry. The transactional and ecological model of coping that emerged from the data describes the dynamic interplay among (a) intrapersonal, interpersonal, and sociocultural factors and (b) the coping process and outcomes of CSA survivors. Implications for research on CSA recovery and culturally appropriate interventions in a collectivistic sociocultural context are discussed.     

A parenting group for women dealing with child sexual abuse and substance abuse

This article describes a group developed to address the parenting needs of women dealing with child sexual abuse and substance abuse. A solution-focused 12-week group intervention is described, and the results of an evaluation are presented. Participants included 29 women who attended seven parenting groups. The results suggest that the group was perceived as beneficial by the women, who reported an increase in self-esteem, parenting satisfaction, and parenting self-esteem and an improvement in their attitudes toward their children.     

Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.     

Context matters: the benefits and costs of expressing positive emotion among survivors of childhood sexual abuse

Positive emotions promote adjustment to aversive life events. However, evolutionary theory and empirical research on trauma disclosure suggest that in the context of stigmatized events, expressing positive emotions might incur social costs. To test this thesis, the authors coded genuine (Duchenne) smiling and laughter and also non-Duchenne smiling from videotapes of late-adolescent and young adult women, approximately half with documented histories of childhood sexual abuse (CSA), as they described the most distressing event of their lives. Consistent with previous studies, genuine positive emotional expression was generally associated with better social adjustment two years later. However, as anticipated, CSA survivors who expressed positive emotion in the context of describing a past CSA experience had poorer long-term social adjustment, whereas CSA survivors who expressed positive emotion while describing a nonabuse experience had improved social adjustment. These findings suggest that the benefits of positive emotional expression may often be context specific.     

A life history assessment of early childhood sexual abuse in women

Life history theory provided a framework for examining the relations among child sexual abuse (CSA), childhood adversity, and patterns of reproductive development and behavior. A community survey that assessed CSA, life history variables (e.g., age of menarche), and social and family background was administered to 623 women (mean age=26.9 years). Independent of social and family background, CSA was associated with earlier age of (a) menarche, (b) first sexual relationship, (c) desire to have children, (d) first childbirth, and (e) lower self-evaluated physical attractiveness. Cluster analyses revealed different patterns of experiential correlates of reproductive development within the group of abused women, suggesting CSA may operate in combination with other childhood circumstances to modify the timing and pattern of individual maturation.     

Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS.

Numerous studies have linked social support to better medication adherence among illness groups, but few have examined potential mechanisms for this relationship. Relationships were examined between social support, depression, positive states of mind (PSOM), and medication adherence among HIV positive men who have sex with men (n = 61) and women (n = 29) on highly active antiretroviral therapy. Depression and PSOM were evaluated as potential mediators of the relationship between support and adherence. Cross-sectional data showed that greater social support and PSOM related to better adherence whereas higher depression scores related to nonadherence. PSOM partially mediated the relationship between social support and adherence. PSOM may be an important mechanism through which social support is related to better medication adherence in this population.     

Cognitive processing therapy for chronic PTSD from childhood sexual abuse: A case study

This paper describes a case of chronic Post-traumatic Stress Disorder (PTSD), as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 4th edn; American Psychiatric Association, 1994). The client has a long history of childhood sexual abuse (CSA), as well as repeated sexual victimization as an adult and addiction issues. She presented with significant avoidance symptoms, including a highly restricted range of affect and distinct feelings of detachment from others. These symptoms had been greatly reduced by the end of the 17-week therapy including both individual and group modalities. The paper elaborates on theoretical issues, the Cognitive Processing Therapy model (Resick & Schnicke, 1993) as it was adapted for use with survivors of childhood sexual abuse, the various phases of the therapeutic process, and specific examples of therapeutic change with this particularly complicated case.     

Harnessing the power of the group for latency-aged sexual abuse victims

For children who have been sexually abused, group therapy is often a preferred treatment modality. Although much consideration has been given to what structured activities, goals, and objectives should be included in groups for sexually abused children, limited attention has been paid to the dynamics and processes inherent in the group. This article follows the dynamic unfolding of a short-term structured group for latency-aged, female sexual abuse victims. Special emphasis is placed on listening to the messages underlying children's actions and responding to the message rather than suppressing or limiting the behavior. It is argued that by attending to group dynamics and processes in a theme-focused group, structured activities become more effective and the power of the group can be harnessed to foster opportunities for healing that otherwise might go unrecognized.     

The association between body image and smoking cessation among individuals living with HIV/AIDS

Lower smoking cessation rates are associated with body image concerns in the general population. This relationship is particularly important to study in individuals living with HIV/AIDS due to alarmingly high smoking rates and considerable bodily changes experienced with HIV disease progression and treatment. The association between body image and smoking cessation rates was examined among individuals living with HIV/AIDS participating in a smoking cessation intervention. Body image concerns were significantly associated with depression, anxiety, stress, and social support, all variables known to affect cessation rates. However, reduced quit rates were found among individuals reporting elevated and low levels of body image concerns at the end of treatment. These findings suggest a unique relationship between smoking and body image among individuals living with HIV/AIDS. Further research is needed to examine these effects and whether moderate levels of body image concerns in this population reflect realistic body perceptions associated with positive mental health.     

Bridging the gap between long- and short-term group psychotherapy: A viable treatment model

The purpose of this paper is to support the efficacy of short-term insight-oriented, process group psychotherapy and to present a unique treatment model. The format for a time-limited, dynamic group therapy model with the opportunity to recontract for additional segments will be discussed. Evidence will be presented that supports the effective use of this model for providing continuity of care for patients with both long- and short-term treatment goals. The referral process,contracting for appropriate goals, group development, the cotherapy relationship, and other specific treatment issues will be addressed.     

A Psychoeducational Group Intervention for Family Members of Persons with HIV/AIDS

We describe a psychoeducational group intervention for family members of persons living with AIDS. The 33 family members were compared with 13 waiting-list controls in order to evaluate the effectiveness of the intervention. We focus on the practice aspects of the intervention, its development and implementation, and our belief that it is an apparently effective approach for helping family members work through the social and emotional aspects of the devastating impact of HIV/AIDS.